WOMEN carrying twins don’t always need to be delivered by Caesarean, but Angelina Jolie’s doctor was bound to err on the side of caution, and surgery was probably the safest option for all concerned. But what if you are not having twins? Have we reached the stage where elective Caesareans are a safer conclusion to a normal pregnancy than a vaginal birth?

There hasn’t been a proper clinical trial testing the theory that, in uncomplicated, low-risk pregnancies (and twins are not low risk) a Caesarean is safer for both baby and mother, so it is impossible to give a definitive answer.

But we do know that there isn’t much in it, and the main advantage of opting for an elective Caesarean is probably that it negates the need for an emergency one – the biggest single hazard faced by women who choose a normal delivery. Add in the convenience of knowing exactly when your child/children will be born and you can see why an increasing number of women are pushing for Caesareans.

This is a trend the National Institute for Health and Clinical Excellence (Nice) is keen to reverse. Its latest guidance to doctors states that “maternal request is not, on its own, an indication for Caesarean section”.

HOW TO RATE YOUR RISK OF A STROKE

Comparing the blood pressure in your arm and lower leg could be a more accurate predictor of your likelihood of dying early from a stroke or heart attack than existing criteria such as cholesterol levels, according to new research published in the Journal of the American Medical Association.

Researchers from Edinburgh University examined the records of nearly 50,000 men and women and found a strong correlation between the ratio of the blood pressure at the ankle and the upper arm – a figure known as the ankle-brachial index (aBi).

Blood pressure should be higher in the ankle than in the arm if the circulation is healthy, but it’s the other way round if there is hardening of the arteries (atherosclerosis) – a process that is as likely to narrow arteries supplying the heart and brain as it is the lower limbs.

The aBi is calculated by dividing the higher (systolic) number from the ankle reading by the one from the arm. So for an average man or woman in their thirties, that might be 130 divided by 120 giving an aBi of 1.1 (normal is anywhere between 1.1 and 1.4). an aBi below 0.9 is associated with a fourfold increase in the chances of dying from a heart attack or stroke within the next ten years.

GPS MUST GET USED TO ONLINE CRITICS

A NEW WEBSITE that allows patients to rate their doctor has upset many GPs and specialists who are concerned that they will be unable to defend themselves against unfair or unfounded criticisms.

The www.iwantgreatcare.org site wants users to rate their doctors anonymously in response to three questions: Do you trust them? Do they listen to you? and would you recommend them to someone else?

Groups such as authors, restaurants and electrical goods manufacturers have been subject to this sort of online review for years and it was only a matter of time before it happened to the medical profession.

We may not like it, but we are probably just going to have to lump it.

DIET IS THE KEY TO WEIGHT LOSS, NOT EXERCISE

THE chances of a child being overweight have more to do with their diet than how active they are, according to recent findings from the EarlyBird study – a research project monitoring the growth and development of 300 children born in the mid-1990s.

While there was a strong correlation between an active lifestyle and healthy blood pressure and cholesterol readings, the researchers found no such relationship with weight. So while encouraging our children to do more is good for their general health, it won’t necessarily improve their waistlines. That’s understandable when you consider that a standard-sized Mars bar contains enough calories to fuel a threemile run.